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[白塞氏葡萄膜炎患者的临床特征]

[Clinical features of patients with Behcet's uveitis].

作者信息

Liu X S, Gao F, Zhao C, Zhang M F

机构信息

Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China, is now working at the Department of Ophthalmology, the Fourth People's Hospital of Shenyang, Shenyang 110031, China.

出版信息

Zhonghua Yan Ke Za Zhi. 2020 Mar 11;56(3):217-223. doi: 10.3760/cma.j.issn.0412-4081.2020.03.010.

Abstract

To characterize the clinical features of patients with Behcet's uveitis. Retrospective case series study. Medical records of patients who were diagnosed as Behcet's uveitis in Peking Union Medical College Hospital between January 1998 and November 2015 were retrospectively reviewed. Information about the clinical manifestation, complication, best corrected visual acuity (logarithm of the minimum angle of resolution) and medication was collected. The correlation of visual acuity and the disease course, as well as inflammation relapse times before and after biological agents applied was analyzed. Chi square test and Wilcoxon signed-rank test were applied for statistical analysis. A total of 132 patients (233 eyes) with Behcet's uveitis were included, among which 104 (78.8%) were male and 28 (21.2%) were female, with statistically significant difference (χ(2)=43.76, 0.01). The average age at the onset of uveitis was (28.9±8.7) years, with most patients at 21-40 years (102 cases, 77.3%). Oral aphthae (132 cases, 100.0%) were the most frequent extraocular manifestations, followed by dermatologic lesions (103 cases, 78.0%), genital ulcers (90 cases, 68.2%), arthritis (44 cases, 33.3%) and positive pathergy test (39 cases, 29.5%). Ocular involvement was bilateral in 76.5% (101 cases) of the patients, and panuveitis was the most common type (110 cases, 83.3%). Complications were seen in 80.7% (188/233) of the eyes, with cataract (58.8%, 137/233) and macular edema (59.1%, 114/193) being the most common anterior and posterior segment complications, respectively. At the eighth year of uveitis, best corrected visual acuity decreased to less than 0.3 in 20.9% (9/43) of the eyes, and more than 1.0 in 39.5% (17/43) of the eyes. A combination of glucocorticoids and immune modulators remained the first line therapy (97.0%, 128/132) for Behcet's uveitis. For 16 refractory cases, an addition of biological agents significantly reduced the inflammation relapse [0.5 (0.0, 1.5) times per year . 4.0 (1.0, 5.5) times per year, -2.81, 0.005]. Behcet's uveitis mainly affects working-age males and manifests as bilateral panuveitis. Complications are commonly seen in uveitic eyes. Patients' visual acuity is significantly impaired. A combination of glucocorticoids and immune modulators is effective for most patients, but for refractory cases, an addition of biological agents provides better effects. -.

摘要

描述白塞氏葡萄膜炎患者的临床特征。回顾性病例系列研究。对1998年1月至2015年11月在北京协和医院被诊断为白塞氏葡萄膜炎的患者病历进行回顾性分析。收集患者的临床表现、并发症、最佳矫正视力(最小分辨角对数)及用药情况。分析视力与病程的相关性,以及应用生物制剂前后炎症复发次数。采用卡方检验和Wilcoxon符号秩和检验进行统计学分析。共纳入132例(233只眼)白塞氏葡萄膜炎患者,其中男性104例(78.8%),女性28例(21.2%),差异有统计学意义(χ(2)=43.76,P<0.01)。葡萄膜炎发病的平均年龄为(28.9±8.7)岁,多数患者年龄在21 - 40岁(102例,77.3%)。口腔溃疡(132例,100.0%)是最常见的眼外表现,其次是皮肤病变(103例,78.0%)、生殖器溃疡(90例,68.2%)、关节炎(44例,33.3%)和针刺反应阳性(39例,29.5%)。76.5%(101例)的患者眼部受累为双侧,全葡萄膜炎是最常见的类型(110例,83.3%)。80.7%(188/233)的眼出现并发症,白内障(58.8%,137/233)和黄斑水肿(59.1%,114/193)分别是最常见的前段和后段并发症。葡萄膜炎发病第8年时,20.9%(9/43)的眼最佳矫正视力降至0.3以下,39.5%(17/43)的眼最佳矫正视力大于1.0。糖皮质激素和免疫调节剂联合应用仍是白塞氏葡萄膜炎的一线治疗方法(97.0%,128/132)。对于16例难治性病例,加用生物制剂可显著减少炎症复发[每年0.5(0.0,1.5)次 对 每年4.0(1.0,5.5)次,-2.81,P=0.005]。白塞氏葡萄膜炎主要影响青壮年男性,表现为双侧全葡萄膜炎。葡萄膜炎性眼常见并发症。患者视力明显受损。糖皮质激素和免疫调节剂联合应用对多数患者有效,但对于难治性病例,加用生物制剂效果更佳。

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